What is done during a cardiac catheterization (heart cath)?

From the Guidelines

During a heart catheterization, doctors insert a thin, flexible tube called a catheter into a blood vessel, usually in the groin, arm, or neck, and thread it to your heart, allowing for the examination of heart function, measurement of pressures, and assessment of coronary arteries and heart valve function, as recommended by the 2019 AHA/ACC guideline for the management of adults with congenital heart disease 1. This procedure provides unique information not reliably available from other diagnostic modalities, such as direct measurement of pressures and resistances, and physiological or anatomic simulation to allow additional calculation or anatomic visualization. The procedure typically involves the injection of contrast dye through the catheter to make blood vessels visible on X-ray imaging (angiography), and may also include interventions like angioplasty or placing stents. Before the procedure, local anesthesia at the insertion site and possibly mild sedation are administered to help the patient relax, and the procedure usually takes 30 minutes to 2 hours, depending on what's being done. Afterward, the patient needs to lie flat for several hours while the insertion site heals to prevent bleeding. Heart catheterization is valuable because it provides detailed information about heart function and blood flow that other tests cannot, helping doctors diagnose conditions and determine appropriate treatments, as supported by the 2019 guideline 1. The importance of properly preparing the patient for the study cannot be overemphasized, including obtaining informed consent and briefing the patient on the procedure, its potential benefits and complications, as emphasized in the 1991 ACC/AHA guidelines for cardiac catheterization and cardiac catheterization laboratories 1. Additionally, the use of proper sterile techniques, protection from blood-transmitted diseases, and postprocedural care, including monitoring and emergency treatment of any complication, are crucial for ensuring patient safety, as highlighted in the 1991 guidelines 1. It is also essential to note that cardiac catheterization in pediatric patients requires special consideration, including the need for either conscious sedation or general anesthesia, and the importance of experienced teams undertaking the procedure, as recommended in the 2015 pediatric pulmonary hypertension guidelines 1.

From the Research

Heart Catheterization Procedure

During a heart catheterization, also known as a cardiac cath, several steps are involved:

• Insertion of a catheter into an artery in the leg or arm
• Guiding the catheter to the heart using fluoroscopy
• Injecting contrast dye to visualize the heart's blood vessels
• Measuring blood pressure and oxygen levels in the heart
• Taking blood samples or performing other diagnostic tests

Sedation and Anesthesia

Sedation and anesthesia are commonly used during heart catheterization to reduce discomfort and anxiety:

• Sedation using anxiolytic and analgesic medications can help alleviate symptoms 2
• The decision to use sedation, and which agent(s) and dose, should be individualized based on patient factors 2
• Anesthesiologists play a crucial role in cardiac catheterization procedures, and their involvement has been evolving over the years 3
• The choice of anesthetic technique, including sedation, general anesthesia, or regional anesthesia, depends on the procedure and patient needs 3

Challenges and Considerations

Heart catheterization poses certain challenges, including:

• Radiation exposure, which requires anesthesiologists to take protective measures 3
• Limited space and personnel in the catheterization laboratory, requiring anesthesiologists to be adaptable 3
• The need for effective communication between anesthesiologists and cardiologists to ensure patient safety 3